If our public services are now consistently arriving at the wrong outcomes, then perhaps it is because they are motivated by the wrong questions. Once, when faced with vulnerable people arriving at hospital doors, the ethos of the National Health Service was: “What can we do to help them?”

Today, other questions frequently appear to be uppermost in the minds of staff, namely: “What can I do to reduce my workload?” and “How can I avoid blame?” And of course — while these questions may have their own internal logic among pressured employees — they are often the active enemies of the main purpose of a hospital: to heal the sick.

The miserable stories oozing out of Stafford Hospital, raised again last week by Robert Francis, QC, make a grim litany of “appalling care”.

I have been in enough hospitals to know that this culture has not spread throughout the NHS, and there are many wards in which staff succeed in doing their absolute best. Still, the two questions of “What can I do to reduce my workload?” and “How can I avoid blame?” are now widespread across our public services, from hospitals to housing to policing. Their effect is both insidious and toxic. People are not seen as individuals with distinctive needs, but simply problems of varying sizes, to be shuffled around or juggled according to which of them creates the most pressing bureaucratic irritation at the time.

Take, for example, the tragic and preventable story of Suzanne Dow, the young academic who killed herself recently in Beeston, Nottinghamshire, after enduring a three-year campaign of harassment by her brawling and drug-dealing neighbours. Miss Dow, who owned her house, repeatedly pleaded with the council to take action: her calls and emails to the relevant housing officer mostly went unanswered. The police picked up on the contemptuous tone: indeed – in response to another desperate letter from Miss Dow – the officer concerned emailed the housing officer to say: “You just can’t win with some people, can you?”

What it came down to was not who was morally or legally right, but who was creating the biggest problem. It was, no doubt, more of a headache for the authorities to evict the turbulent neighbours than to tolerate the continued distress of the law-abiding Miss Dow. And so, by some perverted bureaucratic logic, Miss Dow became the one to blame for complaining.

This case struck a chord with me, because I recently became involved in one with similar circumstances, although hopefully a better long-term outcome. The woman I employ as a nanny to my children, an unfailingly kind, polite and stoic person, had endured harassment for years from her neighbour on the London housing estate in which she lived. It escalated: the neighbour – who did not work – took to banging ferociously on the wall in normal daytime hours, frequently howling obscene racist abuse in protest at perceived noise, while playing his loud music very late into the night.

The response from the housing officer was sluggish: many phone calls were not returned. Our nanny was, however, provided with an “incident diary” in which she recorded the nature and effect of the harassment: it made heartbreaking reading. Her young daughter was so comprehensively terrorised that she refused to return, going instead to live with her grandmother.

After one particularly vile extended outburst, our nanny complained to the police and her neighbour was arrested, only for the case to collapse due to some technicality. When the neighbour returned home, the policeman concerned warned our nanny’s family to stay somewhere else, as their tormentor was deemed volatile; they moved out.

In an effort to help resolve things, I contacted the social housing group responsible, purveyor of glossy brochures about their measures on anti-social behaviour. They came up with non-solutions in pseudo-sympathetic tones. They actually suggested a “flat-swap” with some other unsuspecting family. They offered two alternative properties (one much smaller) on a different London housing estate, which our nanny was wary of, and with reason. Eventually, they argued surreally that because – after four months continuing to pay them full rent for an empty flat from which her family had been hounded – she ceased payment, she had “surrendered her tenancy” and with it her automatic right to rehousing. The decent victim had been duly punished: her family, split up and dependent on the kindness of relatives, is now effectively homeless. The last I heard, her neighbour was still in situ.

I realised what had happened. Like so many others, she had fallen prey to the new British institutional ethos of “What can I do to reduce my workload?” and “How can I avoid blame?”

Pout it like Beckham? No thanks

David Beckham has appeared in an advertisement for his underwear line for H&M, directed by Guy Ritchie, in which Mr Beckham’s dressing gown — in a twist on the old burlesque move — gets caught in the door of the car ferrying his children to school, and he is left in naught but his underpants: pouting and chasing after the departing vehicle in an extravagant manner that shows off his muscular form to perfection.

The advertisement, a strategic combination of the camp and the serious, is

meant to inspire laughter, lust and awe.

With no desire to insult Beckham, who seems a generous and courteous fellow, I find I am only capable of the first reaction. He is, of course, in great shape for a man of 37, or indeed any age: it is just that he looks too much as if he knows it.

To find this a drawback clearly marks me out as someone who is getting on a bit. How one views overt masculine posing is a generational marker that divides those of us who came of age before the internet from the spawn of Facebook: the web has decontaminated narcissism.

Advertisers, should you wish to appeal to women born before 1975, just show us a picture of a good-looking man who doesn’t look as if he is on first-name terms with the ladies at the local waxing parlour, and seems broadly unaware of his own appeal. He doesn’t have to be hurdling over any bins, either. Perhaps he could just be putting them out.

Money and the misery factor

The debate has been raging, not least in the pages of the Telegraph, over whether money can buy happiness. The answer is that it invariably purchases the most joy for those who have the least of it.

Money does best at the extremes of need, where it pays for inoculations and medical treatment, food and shelter. The good of it is clearest when you are thirsty and it buys a drink of water, not when it permits you to choose the Veuve Clicquot over the cava.

If debt can cause jagged worry, then cash acts as the balm that soothes away the terrors of repossessions and loan sharks.

Too much, however, can grease the path to self-destruction – one thinks of the Tetra Pak heir Hans Rausing and his late wife Eva, tragically emaciated by heroin in their Belgravia home.

Then I heard about Gert-Rudolf “Muck” Flick, the Daimler-Benz heir, who is enraging his neighbours, including the cellist Julian Lloyd Webber, with a three-year building project to hollow out a huge basement beneath his £30 million South Kensington house — a space fit for a cinema, beauty-treatment rooms and extra clothes storage. And it struck me that money might not always buy happiness, but it can certainly make other people miserable.